Who Are These People Anyway? The Gang of Six and the Politics of Health Care Reform

The fate of health care reform may well now rest in the hands of a small group of Senators, three Republicans and three Democrats, who have come to be called the Gang of Six. Hand-picked by Senate Committee Finance Chair Max Baucus (D-MT), they have been assigned the elusive task of brokering a bipartisan deal -- a grand bargain -- that can attract broad support from both Republicans and Democrats. With the outcome of perhaps the most significant domestic legislation since Social Security hanging in the balance, the question arises: who are these six Senators and whom do they represent?

In terms of the states from which they come -- Iowa (Grassley-R), Maine (Snowe-R), Montana, New Mexico (Bingaman-D), North Dakota (Conrad-D), and Wyoming (Enzi-R) -- one can hardly imagine a group of Senators less representative of the entire country. Comprising well under 3 percent of the nation's population, these six states do not include a single large or even mid-sized state; in fact, 11 states have larger populations than all of them combined, with California alone having over four times the total number of inhabitants. Of the nation's 60 most populous metropolitan areas, these six states contain not a single one. But the unrepresentative character of the six states goes far beyond their sparse populations; they are strikingly racially homogeneous, with none of them more than 2.4 percent black (Iowa), and three of them less than 1 percent black (Montana, Wyoming, and North Dakota); in contrast, for the United States as a whole, blacks constitute 12.4 percent of the population. Surely in a nation that prides itself as having a government "of the people, by the people, and for the people," the stunning unrepresentativeness of the six Senators poses grave problems for democratic legitimacy.

But the problems with the Gang of Six go far beyond the sheer demographic unrepresentativeness. For they are also -- despite their claim to occupy the political center -- ideologically unrepresentative. Though Baucus himself has a plausible claim to being a centrist, the same cannot be said of ranking Republican, Charles Grassley. While apparently enjoying a close personal relationship with Baucus, Grassley is in fact a conservative Republican (recently ranked the 19th most conservative member of the Senate by the National Journal) and an outspoken opponent of any kind of public insurance option -- a reform that polling data has shown is supported by a strong majority of the American people. Still less representative is Gang of Six member Mike Enzi (R-WY), recently ranked as tied for the most conservative member of the entire Senate by the non-partisan National Journal in an analysis of votes cast in 2008. Clearly, the Group of Six (as its members prefer to be called) represents not the moderate center of American politics, but a position well to the right of center.

Having established that the Gang of Six is decidedly unrepresentative both demographically and ideologically, the possibility nonetheless remains that it is precisely the kind of disinterested bipartisan body that could break the political gridlock so common in Washington and broker a deal serving the broad interests of the American people. Yet though it is undeniably bipartisan, the Group of Six is anything but disinterested. Exhibit A is Committee Chair Max Baucus, who during the last two election cycles received more campaign contributions from the health insurance and pharmaceutical industries than any other current Democratic member of the Senate or House. Since 1989, Senator Baucus has received a staggering $25 million in contributions from health industry Political Action Committees. These contributions have apparently not gone unrewarded; in 2003, Baucus was a major broker in the compromise that led to a major (and highly profitable) expansion of drug benefits for senior citizens and sided with those who succeeded in prohibiting the federal government from negotiating lower prices with the pharmaceuticals.

Exhibit B is Senator Enzi, who has received a greater share of his campaign contributions from Health Industry PACs than any other Senator. Senator Enzi is a particularly crucial player on health care reform, for he is also a member of the Senate Health, Education, Labor and Pensions (HELP) Committee. During the markup hearings for the bill sponsored by the HELP Committee, as documented in an excellent piece by Jonathan Cohn, Senator Enzi showed himself to consistently place the interests of big insurance companies first, proposing amendments to slash government subsidies for people who need help in buying insurance, cut the minimum benefits packages that all insurance policies would be required to supply, and weaken regulations to prevent discrimination against the sick.

While Baucus and Enzi are perhaps the most dramatic cases of corporate influence, every single one of the Gang of Six has been the recipient of disproportionate contributions from the health care industry. In an analysis of the proportion of campaign contributions of U.S. Senators coming from health industry PACs, four of the six members of the Gang of Six were in the top 10 (Enzi, Conrad, Baucus, and Grassley), and the other two were in the top 20 (Bingaman, Snowe). Whether such a group can vigorously represent the public interest rather than the interests of the powerful corporations who fund them so lavishly is questionable, to say the least.

Nevertheless, the Gang of Six may well hold the fate of health care reform in its hands. For if any bipartisan deal with a serious chance of passage is to emerge, this is the group that will be its architects. Now scheduled to report back to the Senate on September 15th, the Gang represents to many the last best hope for a compromise that could attract substantial support from Democrats and Republicans alike.

But the question remains, by what right should a group of six Senators who are grossly unrepresentative of America's population, tilted ideologically well to the right of center, and deeply beholden to the corporate behemoths of the health care industry design what is likely to be one of the most important pieces of legislation of the last forty years? Amidst the heated political back and forth of the moment, it is easy to forget that what is at stake is quite literally a matter of life-and-death; according to the Institute of Medicine of the National Academy of Sciences, 18,000 Americans die each year for lack of health insurance.

How to reform America's deeply troubled health care system is a task that would challenge even the strongest and most representative of our democratic institutions. Entrusting it to a hand-picked group of six Senators so deeply unrepresentative of the country as a whole is a decision that neither the American people nor its elected representatives in the House and Senate should tolerate.